- Email: [email protected]
PW183 Latin American Survey 2013 on Hypertension
PW182 Factors influencing on endothelial dysfunction in patients with arterial hypertension combined with coronary artery disease Natalia Musikhina1, Tatiana Petelina1, Ludmila Gapon1, Elena Mahneva1, Vadim Kuznetsov*1 Tyumen Cardiology Center, Tyumen, Russian Federation
General practitioners (%)
Clinicians (%)
Cardiologists (%)
Others physicians and non- physicians (%)
Diagnosis
50
20
22
8
Follow-up
38
22
29
11
Treatment
39
25
30
2
2) Use of guidelines Most used guidelines were JNC 7 (15), ESC guidelines (13), national guidelines (10) and/or Nice guidelines (3). 3) Medications Specific medications for treatment were endorsed by the government in 13 countries and 9 countries had specific medications recommended. In 9 countries there were programs/ agreements among pharmaceutical companies/drug manufacturers/government to decrease cost and/or increase availability of medications. 4) Barriers for prescription/compliance Lack of patient understanding for long-term need for medication (100%), lack of effective tools for follow-up (89%), cost of medications (84%), lack of skill among providers to motivate/support patient adherence (63%), lack of consistent availability of prescribed medications (53%), and varying opinions about the recommended medication (21%). Conclusion: Diagnosis/follow-up/treatment of HT are performed in most cases by physicians. There is widespread use of different guidelines. Despite specific medications for treatment of HT being endorsed by the government in most countries, and several of them having programs and/or agreements to decrease cost and/or increase availability of medications, there are still powerful barriers for prescription and compliance. Disclosure of Interest: None Declared
1
Introduction: Arterial hypertension (AH) is one of the major risk factors for atherosclerosis, especially for coronary artery disease (CAD), therefore, these diseases are frequently accompanied by each other. Endothelium becomes a target organ for these diseases. Objectives: To define factors influencing on endothelial dysfunction in patients with AH combined with CAD. Methods: 121 patients (mean age 54.490.78 years) were examined. I group included 18 patients without AH and CAD, II group – 57 patients with AH, III group – 46 patients with AH combined with CAD. Patients in all groups were matched for gender, body mass index (BMI), circadian index (CI) of BP (dippers with CI 10-20% and nondippers with CI <10%), level of endothelium-dependent vasodilation (EDV) >10% and <10%. All patients underwent 24-hour blood pressure monitoring and ECG with heart rate variability (HRV) assessment. Pulse wave velocity was measured in elastic arteries (R\L-PWV). Results: The comparison of three groups revealed no significant difference in EDV level. Male patients showed a decrease in EDV in response to AH and CAD (males: I group – 9.591.23%, II – 6.420.91%, III – 8.211.23%; females: I – 10.511.40%, II – 9.830.78%, III – 8.341.09%). In group with AH significant differences in EDV between male and female patients were detected (6.420.91% vs 9.830.73%, p<0.05). Patients with AH and CAD with BMI >30 demonstrated lower EDV vs patients without obesity (10.10.98% vs 7.570.80%, p<0.05). The lowest EDV was observed in patients of III group – nondippers (II group, dippers – 12.732.30%, nondippers – 7.360.72%, p<0.05; III, dippers – 11.411.59%, nondippers – 6.321.40%, p<0.05). Subjects with impaired EDV in group with AH and CAD showed increase in PWV compared with healthy subjects (I group, R-PWV – 11.230.22 m/s vs L-PWV – 11.380.10 m/s; III – 14.200.62 m/s vs 11.230.22 m/s, p<0.05), and decrease in HRV – LF and VLF that indicates the tone of the sympathetic division of the sympathetic nervous system: LF (I group – 1447.80647.39 m/s2, III – 404.2560.61 m/s2, p<0.05) and VLF (1867.44234.31 m/s2 vs 1210.75117.09 m/s2, p<0.05). Conclusion: Male sex, obesity, abnormal circadian index of BP influence on endothelial dysfunction in patients with AH combined with CAD during reduction in the sympathetic nervous system tone that may cause impaired vessel wall elasticity. Disclosure of Interest: None Declared
PW185 Efficacy of LCZ696, an angiotensin receptor neprilysin inhibitor (ARNI), in patients with systolic hypertension Joseph L. Izzo*1, Dion H. Zappe2, Yan Jia2, Kudsia Hafeez2, Jack Zhang2 1 Clinical Pharmacology, State University of New York, Buffalo, NY, 2Novartis Pharmaceuticals Corporation, East Hanover, NJ, United States Introduction: The progressive increase in arterial stiffness that occurs with aging makes systolic hypertension (SH) difficult to treat. The anti-hypertensive drug LCZ696 (Japanese Adopted Name [JAN]: Sucabitril Valsartan Sodium Hydrate), a first-in-class ARNI, may have unique effects on arterial stiffness and SH. Objectives: To compare the efficacy of LCZ696 against valsartan (V) in patients with SH (mean sitting [ms] systolic blood pressure [SBP]150 mmHg) and isolated SH (ISH, msSBP150 mmHg and ms diastolic BP [DBP]<90 mmHg). Methods: Subjects included in this analysis participated in an 8-week, multicenter, randomized, double-blind, placebo- and active-controlled, parallel-arm study. Primary dependent variable was the change in SBP at 8 weeks; pulse pressure (PP) and mean ambulatory (ma) BP were also evaluated. Results: Overall, 343 patients with SH (age 61 years, 48% 65 years, 68% Caucasian, body weight 82.4 kg, body mass index 29.9 kg/m2, duration of hypertension 8.7 years) were randomized to placebo (n¼58), V 320 mg (n¼143) or LCZ696 400 mg (n¼142). Baseline msSBP, msDBP, and msPP were 159.8, 90.2, and 69.6 mmHg, respectively. ISH was present in 159 patients (46.4%); baseline msSBP, msDBP, and msPP were 159.2, 82.4, and 76.7 mmHg, respectively. After 8 weeks of treatment for SH, LCZ696 400 mg lowered msSBP more than V (5.7 mmHg, p<0.001), along with msPP (3.4 mmHg, p<0.05) and 24-hour maSBP (-3.4 mmHg, p<0.001). Similar results were obtained for ISH (Table).
SH
PW183
Mean (SD)
Latin American Survey 2013 on Hypertension Daniel J. Piñeiro*1, Marcia M. Barbosa2, Wistremundo Dones3, Araceli Delgado4, On behalf the Interamerican Society of Cardiology 1 Hospital de Clínicas "José de San Martin", Universidad de Buenos Aires, Buenos Aires, Argentina, 2Hospital Socor, Belo Horizonte, Brazil, 3Ryder Memorial Hospital, Humacao, Puerto Rico, 4Interamerican Society of Cardiology, Mexico City, Mexico Introduction: High blood pressure is the leading risk factor for heart attack and stroke, and is responsible for over 7 million, largely preventable, deaths each year worldwide. Similar to the global situation, in Latin America (LA), hypertension (HT) is common and poorly controlled. Objectives: This survey aimed to collect data on the clinical practices in the management of adult patients with HT in LA. Methods: A survey was sent to the 20 Presidents of the LA national societies/associations of Cardiology, contacted between October 2011 and February 2012. Results: Responses were received from 19 societies (95%). 1) Diagnoses, follow-up, and treatment
GHEART Vol 9/1S/2014
j
March, 2014
j
POSTER/2014 WCC Posters
Placebo
LCZ696 400 mg
ISH Valsartan 320 mg
Placebo
LCZ696 400 mg
Valsartan 320 mg
N
58
142
143
25
64
70
msSBP
-6.515.4
-21.513.7
-15.714.8
-8.210.6
-21.712.9
-15.814.9
msDBP
-3.510.5
-9.69.6
-6.98.7
-1.08.9
-5.78.5
-5.38.5
msPP
-3.011.6
-11.910.9
-8.812.4
-7.210.3
-16.010.2
-10.513.6
maSBP
-0.89.1
-13.69.3
-9.911.9
-0.99.3
-11.910.1
-9.812.4
maDBP
0.15.2
-6.66.4
-5.18.1
+0.53.9
-4.46.4
-5.19.0
All treatments were safe and well tolerated: adverse events with LCZ696 (29.6%) and V (26.6%) were similar to placebo (34.5%). Conclusion: LCZ696 is superior to valsartan in reducing clinic and 24-hour ambulatory SBP in SH and ISH and is thus an attractive treatment strategy for SH. Proof of a direct effect of ARNI on arterial stiffness requires additional study.
e295
POSTER ABSTRACTS
and 24-hour blood pressure monitoring; biochemical parameters (total cholesterol, lowdensity lipoprotein cholesterol, high-density lipoprotein cholesterol, triglyceride, malonic dialdehyde (MD) and inflammatory markers -homocysteine and hs-CRP) were estimated. Results: In group I there was registered significant increase in sphygmography indices (pulse wave velocity (PWV) – normal importance <12 m/s, cardio-ankle vascular index), in mean 24-hour and mean daytime systolic blood pressure (SBP), in time and square indices and in day time SBP variability (p<0.001) and decrease in ancle-brachial index. In biochemical parameters significant increase in total cholesterol (p¼0.000), low-density lipoprotein cholesterol (p¼0.034), triglyceride level (p¼0.002), MD level (p<0.05) and in inflammatory markers - homocysteine (p¼0.000) and hs-CRP level (p¼0.001); decrease in high-density lipoprotein cholesterol (p¼0.001) was found compared to group II patients. Besides in group I there was detected positive correlation between inflammatory and lipid markers with parameters of sphygmography and 24-hour blood pressure monitoring. It was shown that with an increase in total cholesterol level m>5.0 mmol/l, the risk of high rate PWV>12 m/s in patients with AH and AO increased by 15 times. Besides we revealed that high levels of endothelin-1 and homocysteine were observed more frequently in women than in men, with an increase at 1 fmol/l the risk of high rate PWV>12 m/s increased by 2.6 times and 35%, respectively. Conclusion: The relationship between the markers of inflammation, endothelial dysfunction, parameters of atherogenic lipids and vascular remodeling process factors indicates a high risk of progression of hypertension and cardiovascular complications in patients with AH and AO. Disclosure of Interest: None Declared
General practitioners (%)
Clinicians (%)
Cardiologists (%)
Others physicians and non- physicians (%)
Diagnosis
50
20
22
8
Follow-up
38
22
29
11
Treatment
39
25
30
2
2) Use of guidelines Most used guidelines were JNC 7 (15), ESC guidelines (13), national guidelines (10) and/or Nice guidelines (3). 3) Medications Specific medications for treatment were endorsed by the government in 13 countries and 9 countries had specific medications recommended. In 9 countries there were programs/ agreements among pharmaceutical companies/drug manufacturers/government to decrease cost and/or increase availability of medications. 4) Barriers for prescription/compliance Lack of patient understanding for long-term need for medication (100%), lack of effective tools for follow-up (89%), cost of medications (84%), lack of skill among providers to motivate/support patient adherence (63%), lack of consistent availability of prescribed medications (53%), and varying opinions about the recommended medication (21%). Conclusion: Diagnosis/follow-up/treatment of HT are performed in most cases by physicians. There is widespread use of different guidelines. Despite specific medications for treatment of HT being endorsed by the government in most countries, and several of them having programs and/or agreements to decrease cost and/or increase availability of medications, there are still powerful barriers for prescription and compliance. Disclosure of Interest: None Declared
1
Introduction: Arterial hypertension (AH) is one of the major risk factors for atherosclerosis, especially for coronary artery disease (CAD), therefore, these diseases are frequently accompanied by each other. Endothelium becomes a target organ for these diseases. Objectives: To define factors influencing on endothelial dysfunction in patients with AH combined with CAD. Methods: 121 patients (mean age 54.490.78 years) were examined. I group included 18 patients without AH and CAD, II group – 57 patients with AH, III group – 46 patients with AH combined with CAD. Patients in all groups were matched for gender, body mass index (BMI), circadian index (CI) of BP (dippers with CI 10-20% and nondippers with CI <10%), level of endothelium-dependent vasodilation (EDV) >10% and <10%. All patients underwent 24-hour blood pressure monitoring and ECG with heart rate variability (HRV) assessment. Pulse wave velocity was measured in elastic arteries (R\L-PWV). Results: The comparison of three groups revealed no significant difference in EDV level. Male patients showed a decrease in EDV in response to AH and CAD (males: I group – 9.591.23%, II – 6.420.91%, III – 8.211.23%; females: I – 10.511.40%, II – 9.830.78%, III – 8.341.09%). In group with AH significant differences in EDV between male and female patients were detected (6.420.91% vs 9.830.73%, p<0.05). Patients with AH and CAD with BMI >30 demonstrated lower EDV vs patients without obesity (10.10.98% vs 7.570.80%, p<0.05). The lowest EDV was observed in patients of III group – nondippers (II group, dippers – 12.732.30%, nondippers – 7.360.72%, p<0.05; III, dippers – 11.411.59%, nondippers – 6.321.40%, p<0.05). Subjects with impaired EDV in group with AH and CAD showed increase in PWV compared with healthy subjects (I group, R-PWV – 11.230.22 m/s vs L-PWV – 11.380.10 m/s; III – 14.200.62 m/s vs 11.230.22 m/s, p<0.05), and decrease in HRV – LF and VLF that indicates the tone of the sympathetic division of the sympathetic nervous system: LF (I group – 1447.80647.39 m/s2, III – 404.2560.61 m/s2, p<0.05) and VLF (1867.44234.31 m/s2 vs 1210.75117.09 m/s2, p<0.05). Conclusion: Male sex, obesity, abnormal circadian index of BP influence on endothelial dysfunction in patients with AH combined with CAD during reduction in the sympathetic nervous system tone that may cause impaired vessel wall elasticity. Disclosure of Interest: None Declared
PW185 Efficacy of LCZ696, an angiotensin receptor neprilysin inhibitor (ARNI), in patients with systolic hypertension Joseph L. Izzo*1, Dion H. Zappe2, Yan Jia2, Kudsia Hafeez2, Jack Zhang2 1 Clinical Pharmacology, State University of New York, Buffalo, NY, 2Novartis Pharmaceuticals Corporation, East Hanover, NJ, United States Introduction: The progressive increase in arterial stiffness that occurs with aging makes systolic hypertension (SH) difficult to treat. The anti-hypertensive drug LCZ696 (Japanese Adopted Name [JAN]: Sucabitril Valsartan Sodium Hydrate), a first-in-class ARNI, may have unique effects on arterial stiffness and SH. Objectives: To compare the efficacy of LCZ696 against valsartan (V) in patients with SH (mean sitting [ms] systolic blood pressure [SBP]150 mmHg) and isolated SH (ISH, msSBP150 mmHg and ms diastolic BP [DBP]<90 mmHg). Methods: Subjects included in this analysis participated in an 8-week, multicenter, randomized, double-blind, placebo- and active-controlled, parallel-arm study. Primary dependent variable was the change in SBP at 8 weeks; pulse pressure (PP) and mean ambulatory (ma) BP were also evaluated. Results: Overall, 343 patients with SH (age 61 years, 48% 65 years, 68% Caucasian, body weight 82.4 kg, body mass index 29.9 kg/m2, duration of hypertension 8.7 years) were randomized to placebo (n¼58), V 320 mg (n¼143) or LCZ696 400 mg (n¼142). Baseline msSBP, msDBP, and msPP were 159.8, 90.2, and 69.6 mmHg, respectively. ISH was present in 159 patients (46.4%); baseline msSBP, msDBP, and msPP were 159.2, 82.4, and 76.7 mmHg, respectively. After 8 weeks of treatment for SH, LCZ696 400 mg lowered msSBP more than V (5.7 mmHg, p<0.001), along with msPP (3.4 mmHg, p<0.05) and 24-hour maSBP (-3.4 mmHg, p<0.001). Similar results were obtained for ISH (Table).
SH
PW183
Mean (SD)
Latin American Survey 2013 on Hypertension Daniel J. Piñeiro*1, Marcia M. Barbosa2, Wistremundo Dones3, Araceli Delgado4, On behalf the Interamerican Society of Cardiology 1 Hospital de Clínicas "José de San Martin", Universidad de Buenos Aires, Buenos Aires, Argentina, 2Hospital Socor, Belo Horizonte, Brazil, 3Ryder Memorial Hospital, Humacao, Puerto Rico, 4Interamerican Society of Cardiology, Mexico City, Mexico Introduction: High blood pressure is the leading risk factor for heart attack and stroke, and is responsible for over 7 million, largely preventable, deaths each year worldwide. Similar to the global situation, in Latin America (LA), hypertension (HT) is common and poorly controlled. Objectives: This survey aimed to collect data on the clinical practices in the management of adult patients with HT in LA. Methods: A survey was sent to the 20 Presidents of the LA national societies/associations of Cardiology, contacted between October 2011 and February 2012. Results: Responses were received from 19 societies (95%). 1) Diagnoses, follow-up, and treatment
GHEART Vol 9/1S/2014
j
March, 2014
j
POSTER/2014 WCC Posters
Placebo
LCZ696 400 mg
ISH Valsartan 320 mg
Placebo
LCZ696 400 mg
Valsartan 320 mg
N
58
142
143
25
64
70
msSBP
-6.515.4
-21.513.7
-15.714.8
-8.210.6
-21.712.9
-15.814.9
msDBP
-3.510.5
-9.69.6
-6.98.7
-1.08.9
-5.78.5
-5.38.5
msPP
-3.011.6
-11.910.9
-8.812.4
-7.210.3
-16.010.2
-10.513.6
maSBP
-0.89.1
-13.69.3
-9.911.9
-0.99.3
-11.910.1
-9.812.4
maDBP
0.15.2
-6.66.4
-5.18.1
+0.53.9
-4.46.4
-5.19.0
All treatments were safe and well tolerated: adverse events with LCZ696 (29.6%) and V (26.6%) were similar to placebo (34.5%). Conclusion: LCZ696 is superior to valsartan in reducing clinic and 24-hour ambulatory SBP in SH and ISH and is thus an attractive treatment strategy for SH. Proof of a direct effect of ARNI on arterial stiffness requires additional study.
e295
POSTER ABSTRACTS
and 24-hour blood pressure monitoring; biochemical parameters (total cholesterol, lowdensity lipoprotein cholesterol, high-density lipoprotein cholesterol, triglyceride, malonic dialdehyde (MD) and inflammatory markers -homocysteine and hs-CRP) were estimated. Results: In group I there was registered significant increase in sphygmography indices (pulse wave velocity (PWV) – normal importance <12 m/s, cardio-ankle vascular index), in mean 24-hour and mean daytime systolic blood pressure (SBP), in time and square indices and in day time SBP variability (p<0.001) and decrease in ancle-brachial index. In biochemical parameters significant increase in total cholesterol (p¼0.000), low-density lipoprotein cholesterol (p¼0.034), triglyceride level (p¼0.002), MD level (p<0.05) and in inflammatory markers - homocysteine (p¼0.000) and hs-CRP level (p¼0.001); decrease in high-density lipoprotein cholesterol (p¼0.001) was found compared to group II patients. Besides in group I there was detected positive correlation between inflammatory and lipid markers with parameters of sphygmography and 24-hour blood pressure monitoring. It was shown that with an increase in total cholesterol level m>5.0 mmol/l, the risk of high rate PWV>12 m/s in patients with AH and AO increased by 15 times. Besides we revealed that high levels of endothelin-1 and homocysteine were observed more frequently in women than in men, with an increase at 1 fmol/l the risk of high rate PWV>12 m/s increased by 2.6 times and 35%, respectively. Conclusion: The relationship between the markers of inflammation, endothelial dysfunction, parameters of atherogenic lipids and vascular remodeling process factors indicates a high risk of progression of hypertension and cardiovascular complications in patients with AH and AO. Disclosure of Interest: None Declared